Is There Supposed to Be a Dip in Your Chest? Understanding Pectus Excavatum

September 25, 2025 •

4 min read

According to the Children's Hospital of Philadelphia, pectus excavatum is the most common congenital chest wall deformity. For many, a slight dip in the chest can be a normal and harmless anatomical variation, but it's important to know the signs of more serious cases.

Quick Summary

A dip or indentation in the chest, known medically as pectus excavatum, is caused by abnormal growth of the cartilage connecting the ribs to the breastbone. Its severity can range from a minor cosmetic concern to a condition that affects heart and lung function, emphasizing the need for medical evaluation if accompanied by symptoms.

Key Points

The Cause is Cartilage Growth: A chest dip is medically known as pectus excavatum, caused by an overgrowth of cartilage that forces the sternum inward.
Severity Varies: Pectus excavatum can range from a mild, harmless cosmetic difference to a severe condition that compresses the heart and lungs.
Consider Associated Conditions: While often isolated, the condition can sometimes be linked to other syndromes like Marfan syndrome or scoliosis.
Diagnosis Needs Imaging: To determine severity, a doctor may order a CT or MRI scan to measure the indentation and its impact on your internal organs.
Treatment Depends on Symptoms: Treatment can range from simple observation to surgical correction, depending on the presence of functional problems or significant psychological distress.
Not Always a Problem: A mild, asymptomatic dip in the chest does not always require treatment and may simply be a normal variation of chest anatomy.

What is Pectus Excavatum?

Pectus excavatum, often called funnel chest or sunken chest, is a chest wall deformity where the sternum (breastbone) is sunken into the chest. This gives the chest a caved-in or hollowed-out appearance. The condition is typically present at birth (congenital) but often becomes more noticeable during rapid growth periods, particularly during adolescence. While it is more common in males, it can affect people of all genders.

The severity of pectus excavatum can vary dramatically from person to person. For many, the condition is mild and primarily a cosmetic concern that doesn't impact physical health. In more severe cases, however, the indented breastbone can put pressure on the heart and lungs, potentially leading to medical complications.

Causes and Associated Conditions

The exact cause of pectus excavatum is not always known, but medical experts believe that it's likely linked to an overgrowth of the costal cartilages that connect the ribs to the sternum, forcing the sternum inward. Genetics may also play a significant role, as the condition sometimes runs in families.

While most cases occur in otherwise healthy individuals, pectus excavatum can also be associated with certain connective tissue disorders and genetic syndromes, including:

Marfan syndrome: A disorder that affects the body’s connective tissue.
Poland syndrome: A rare birth defect characterized by the absence or underdevelopment of chest muscles.
Noonan syndrome: A disorder causing various parts of the body to develop abnormally.
Ehlers-Danlos syndrome (EDS): A group of inherited disorders that affect connective tissues.
Scoliosis: An abnormal curvature of the spine.

Symptoms and Impact on Health

The symptoms of pectus excavatum can be both physical and psychological. In mild cases, the only sign may be a slight indentation in the chest. However, when the condition is more severe, it can cause a range of physical issues due to the compression of the heart and lungs.

Physical symptoms may include:

Shortness of breath, especially with exercise
Fatigue and reduced stamina compared to peers
Chest pain
Irregular heartbeats or palpitations
Heart murmur
Frequent respiratory infections
Poor posture, such as rounded shoulders
Dizziness or fainting spells

Psychological symptoms can include anxiety, low self-esteem, and social anxiety, especially in adolescents who feel self-conscious about their appearance.

Diagnosis and Evaluation

If you or your child have a dip in the chest, a healthcare provider will conduct a physical examination and take a thorough medical history. To accurately assess the severity of the condition and its impact on the heart and lungs, additional diagnostic tests may be ordered:

Chest CT or MRI Scan: This is the most accurate way to measure the severity of the indentation and its effect on internal organs. It is used to calculate the Haller index, a ratio that helps determine the level of severity.
Pulmonary Function Tests (PFTs): These tests assess the capacity of the lungs, revealing if they are being compressed or if lung function is impaired.
Echocardiogram: An ultrasound of the heart that checks for compression or displacement and assesses heart function.
Exercise Testing: A cardiopulmonary exercise test can evaluate a person's stamina and tolerance for physical activity, highlighting any functional limitations.

Treatment Options for Pectus Excavatum

The treatment approach for pectus excavatum depends on its severity and the presence of symptoms. For many with a mild condition, observation and reassurance may be sufficient. For more serious cases, several options are available:


Treatment Option	Purpose	Best Suited For
Observation	Monitoring for changes in the deformity and symptoms over time.	Mild, asymptomatic cases, especially in young children.
Bracing	Using a chest-wall brace to apply external pressure and reshape the cartilage.	Moderate pectus carinatum (outward sternum), not typically used for excavatum.
Physical Therapy	Strengthening exercises to improve posture and muscle support.	Mild-to-moderate cases to address poor posture and functional limitations.
Surgical Repair (Nuss Procedure)	A minimally invasive surgery to insert a curved metal bar that pushes the sternum outward.	Moderate-to-severe cases, typically in adolescents.
Surgical Repair (Ravitch Procedure)	An open surgery involving cartilage removal and sternal repositioning.	More severe, complex, or adult cases.

For more information on the condition and treatment options, consult an authoritative medical source like the Cleveland Clinic on Pectus Excavatum.

Conclusion

Ultimately, a dip in the chest can be a normal anatomical feature or a symptom of a condition called pectus excavatum. The vast majority of mild cases cause no health problems and are only of cosmetic concern. However, severe cases can affect heart and lung function and lead to other complications. Seeking a professional medical opinion is the only way to determine the extent of the condition and whether any intervention is necessary. If you experience shortness of breath, chest pain, or significant body image concerns, it is wise to consult a doctor for a full evaluation.

Frequently Asked Questions

Not necessarily. A slight dip can be a normal anatomical variation. A diagnosis of pectus excavatum is usually confirmed by a medical professional, who will assess the depth and overall appearance of the chest indentation.

The Haller Index is a ratio used to measure the severity of pectus excavatum. It compares the width of the chest to the depth of the indentation, with a higher index indicating a more severe deformity. It is typically determined using a CT scan.

You should see a doctor if you experience any physical symptoms like shortness of breath, chest pain, or a rapid heart rate, especially during exercise. It is also advisable to seek a medical opinion if you are significantly bothered by the cosmetic appearance.

Exercise cannot correct the underlying skeletal abnormality of pectus excavatum. However, strengthening the chest muscles can sometimes improve posture and reduce the visibility of the indentation, particularly in mild cases. It will not worsen the condition.

Yes, pectus excavatum is a congenital condition, meaning it is present from birth. While it may not be noticeable at birth, it often becomes more prominent during puberty's growth spurt.

Psychological effects can include feelings of self-consciousness, low self-esteem, and body image issues, particularly for adolescents. Addressing these concerns is often part of a comprehensive treatment plan.

No, surgery is not the only option, but it is often recommended for severe cases that impact heart and lung function. Other options include observation, physical therapy, and non-surgical bracing, depending on the specific situation and severity.